CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 100.00 33.33
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 82.50 4362.50 52.88
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 64 91.50 4753.50 51.95
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 15 15.75 787.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 3.00 150.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 1.00 25.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 91 1210.25 38847.50 32.10
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 41 494.50 14835.00 30.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 49.50 3360.06 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 4 250.00 125.00 0.50
Subtotal (Total Children Is Unduplicated) 121 2025.00 58180.06 28.73
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Total 2116.50 62933.56 29.73
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Number of Children (Unduplicated) With at Least One Service 179
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Center 52
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
726 2116.50 62933.56 0.00
Other 0 0.00 0.00 0.00
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Total 726 2116.50 62933.56 0.00